Effects of a 2-year randomized controlled trial ofparenting centers on caregiver mental health inruralChina.

Caregivers of patients in vegetative state and minimally conscious state play a crucial role in the process of taking care and, as previous studies reported, they can suffer of high burden and negative health outcomes. The aim of this national cross-sectional study was to assess whether physical and mental health of caregivers, considering gender differences, is related to the presence of depressive symptoms, anxiety, age and patient's disease duration. Four-hundred and eighteen caregivers, 294 women and 124 men, completed the State Trait Anxiety Inventory-Y, Beck Depression Inventory, second version and Short Form-12. Hierarchical multiple regression analyses were performed to evaluate to which extent depressive and anxiety symptoms predict physical and mental health. Men reported higher levels of mental health state, whereas physical health was not different across gender. High levels of anxiety symptoms were associated to negative mental health outcomes in both genders, whereas depressive symptoms were found to impact on female's mental and physical health only. A comprehensive and cost-effective screening of anxiety and depressive symptoms may help to identify determinants of health worsening in order to plan, when necessary, caregivers' support. Female caregivers of patients in vegetative state and minimally conscious state have poorer levels of mental health, whereas physical health is similar to men's. Anxiety symptoms are related to negative mental health outcomes in both male and female caregivers, whereas depressive symptoms are found to impact on female mental and physical health only. It is essential to consider and assess depressive and anxiety symptoms as they may contribute to caregivers' health worsening. This knowledge can lead to plan more comprehensive and tailored caregivers' supports and a better care for patients.

BackgroundManaging advanced cancer can be psychologically distressing and burdensome for family caregivers and their care recipients. Innovations in the collection and modelling of passive data from personally-owned smartphones (e.g., GPS), called digital phenotyping, may afford the possibility of remotely monitoring and detecting distress and burden. We explored the potential of using passively-collected GPS data from smartphones to assess and predict caregiver and patient distress and burden.MethodsThis exploratory longitudinal cohort study enrolled smartphone-owning family caregiver and patient participants with advanced cancer (August 2021-July 2023) recruited via an oncology clinic or self-referral through Facebook. Participants downloaded a digital phenotyping research app, called Beiwe, that passively collected GPS data for 24 weeks. Participants completed self-report measures (PROs) of anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS]), mental health (PROMIS Mental Health), and caregiver burden (Montgomery-Borgatta Caregiver Burden scale) at baseline and every 6 weeks for 24 weeks. After pre-processing raw GPS data into daily GPS features (e.g., time spent at home, distance traveled/day), computing biweekly moving averages and standard deviations, and conducting a principal components analysis (PCA) of the resulting variables, within-person regression models were used to assess associations between changes in PRO measures and changes in PCA scores, with adjusted-R2 as the measure of effect size (small = 0.02, medium = 0.13, large = 0.26).ResultsEvaluable data were collected from 48 participants (family caregivers = 32; patients = 16). Caregiver smartphone data explained small-to-medium variance in caregiver anxiety (0.06), depression (0.15), and mental health (0.07). Patient smartphone data predicted small to medium variance in caregiver depressive symptoms (0.12) and burden (0.05). Combined caregiver and patient smartphone data explained small variance in caregiver depressive (0.02) and anxiety symptoms (0.10) and large variance for PROMIS-mental health (0.36) and burden (0.50). For patient outcomes, caregiver smartphone data accounted for small variance in anxiety symptoms (0.07); patient smartphone data predicted large variance in anxiety symptoms (0.24). Combined data explained medium variance in patient depressive symptoms (0.18).ConclusionsThe exploratory study demonstrates the potential predictive utility of using passive smartphone data to detect changes in caregiver and patient psychological distress and burden. A larger study is needed to validate these findings and further explore the clinical application of digital phenotyping in cancer.

In children with cystic fibrosis (CF) sleep, eating/mealtime, physiotherapy adherence and internalising problems are common. Caregivers also often report elevated depression, anxiety and stress symptoms. To identify, through principal components analysis (PCA), coping strategies used by Australian caregivers of children with CF and to assess the relationship between the derived coping components, caregiver mental health symptoms and child treatment related and non-treatment related problem behaviours. One hundred and two caregivers of children aged 3 to 8years from three CF clinic sites in Australia, completed self-report questionnaires about their coping and mental health and reported on their child's sleep, eating/mealtime, treatment adherence and internalising and externalising behaviours. Two caregiver coping components were derived from the PCA: labelled 'proactive' and 'avoidant' coping. 'Avoidant' coping correlated moderately with caregiver depression (0.52), anxiety (0.57) and stress (0.55). For each unit increase in caregiver use of avoidant coping strategies, the odds of frequent child eating/mealtime behaviour problems increased by 1.3 (adjusted 95% CI 1.0 to 1.6, p = .03) as did the odds of children experiencing borderline/clinical internalising behaviour problems (adjusted 95% CI 1.1 to 1.7, p = .01). Proactive coping strategies were not associated with reduced odds of any child problem behaviours. Avoidant coping strategies correlated with caregiver mental health and child problem behaviours. Intervening with caregiver coping may be a way to improve both caregiver mental health and child problem behaviours in pre-school and early school age children with CF.

SummaryLittle is known about depressive and anxious symptoms and quality of life (QOL) in caregivers of children with cystic fibrosis (CF). The aims of this study were to: (1) assess rates of female and male caregiver depressive and anxious symptoms, and (2) evaluate relations between depressive and anxious symptoms, caregiver QOL, and health outcomes.Patients and MethodsEligible participants were caregivers of children with CF who completed three questionnaires assessing depressive and anxious symptoms and caregiver QOL during routine CF Clinic appointments.ResultsRates of depressive and anxious symptoms were elevated in female and male caregivers of children with CF. Rates were higher for anxious (51% for females, 43% for males) than depressive symptoms (20–28% for females; 14–31% for males). Female caregiver depressive symptoms increased as child lung functioning decreased. As depressive and anxious symptoms increased, caregiver QOL decreased. In addition, female caregiver depressive and anxious symptoms were positively correlated with male caregiver anxious and depressive symptoms in a small subsample of couples. CF disease severity and caregiver depressive symptoms predicted caregiver QOL.ConclusionRates of depressive and anxious symptoms are high among caregivers of children with CF. The results of this study highlight the need to screen for female and male caregiver depressive and anxious symptoms in the CF Clinic as CF Team members are well positioned to provided assistance around solving CF-related challenges. In addition, alleviation of depressive and anxious symptoms could potentially lead to improvements in the psychological functioning and well-being of caregivers of children with CF. Pediatr Pulmonol. 2009; 44:784–792. © 2009 Wiley-Liss, Inc.

It is important to identify modifiable factors to reduce the negative impact of pediatric disorders of gut-brain interaction (DGBIs) on the family. The current study examined whether child somatic symptoms and caregiver mental health negatively influenced caregiver and family functioning. Participants were 84 children (8-17 years old) with DGBI symptoms and their caregivers presenting to a specialty DGBI clinic. Participants completed measures assessing demographics, child somatic symptoms, caregiver anxiety and depressive symptoms, and the impact of the child's illness on the family. Regression analyses examined if child somatic symptoms and caregiver and mental health were associated with family outcomes (i.e., Caregiver Health-Related Quality of Life [HRQoL], Family Functioning, Total Family Impact). Mediation analyses examined if child somatic symptoms mediated the association between caregiver mental health and Total Family Impact. Child somatic symptoms (self- and caregiver-report) were negatively related to Caregiver HRQoL, Family Functioning, and Total Family Impact (ps < 0.01). Caregiver anxiety was related to poorer Caregiver HRQoL (p < 0.001) and Total Family Impact (p = 0.01), while caregiver depression was negatively related to Family Functioning (p = 0.01). Self-report of child somatic symptoms partially mediated the association between caregiver anxiety and depressive symptoms and the Total Family Impact. Findings indicate that child somatic symptoms are one pathway by which caregiver mental health may amplify the impact of pediatric DGBIs on the family. This highlights the importance of screening for child somatic symptoms and caregiver mental health in pediatric DGBI treatment.

Previous research has found that there are high rates of mental health problems among caregivers in rural China and that caregiver mental health may be a significant predictor of developmental delays among infants and toddlers in these rural areas. In this paper, we use data from a survey of 986 caregiver-child pairs in rural China to examine the risk factors of caregiver mental health and measure the association between caregiver mental health and child development outcomes. To conduct the empirical analysis, we assess caregiver mental health using the Depression Anxiety Stress Scales-21 (DASS-21) questionnaire and measure child developmental outcomes using the Bayley Scales of Infant and Toddler Developmental Third Edition (Bayley-III). The results show that 32% of caregivers have depressive symptoms, 42% have anxiety symptoms, and 30% have symptoms of stress. The data also demonstrate that caregiver identity and age as well as different measures of socioeconomic status (SES) (characterized by caregiver education, father’s education, and household wealth) are all significantly linked to symptoms of caregiver mental health problems. The analysis shows that caregiver depression, anxiety, and/or stress are significantly associated with lower early childhood development (ECD) outcomes in all areas measured (cognition, language, social-emotion, and motor skills). The heterogeneous analysis demonstrates that there are differences in the effects of caregiver mental health problems on ECD among households are from families that are endowed with different levels of SES. On the basis of the findings the study concludes that policymakers should pay more attention to caregiver mental health problems in order to improve child developmental outcomes in rural China. The study cannot, however, draw casual conclusions and cannot rule out the possibility of recall bias when measuring caregiver mental health, which may limit the external validity of the findings.

It was verified the level of religiosity and spirituality, and symptoms of depression, stress, and anxiety of caregivers of children and adolescents with type 1 diabetes, and its interference in glycaemic control. Socio-economic and demographic data were collected from caregivers of 59 children and adolescents with type 1 diabetes and obtained dosages of fasting glucose (FG); postprandial glycaemia (PPG); fructosamine (FRUTO); and HbA1c, as well as the glycaemic variability-∆HbA1c. Levels of religiosity were obtained by the DUREL scale; the use of religious/spiritual coping was verified by the SRCOPE-Brief scale. Symptoms of depression, anxiety, and stress were analysed by the DASS-21 scale. The correlations between the variables were analysed by the Pearson coefficient, with significance at 5% level. Inverse correlations were observed between caregivers' schooling with PPG (r = -0.30; P = 0.002) and FRUTO (r = -0.34; P = 0.008) and between family income and FRUTO (r = -0.37; P = 0.004). Direct, moderate correlations were observed between negative religious/spiritual coping (NSRCOPE) with symptoms of depression (r = 0.588; P < 0.0001), stress (r = 0.500; P < 0.0001), and anxiety (r = 0.551; P < 0.0001). The direct association between NSRCOPE with symptoms of depression, stress, and anxiety was the highlighted item in the present study emphasizing the need for greater attention to the emotional health of informal caregivers of children and adolescents with DM1. It is necessary to reflect on the religious/spiritual support especially for the main caregiver of children and adolescents with DM1.

Post-traumatic stress, anxiety, and depressive symptoms in caregivers of children tested for COVID-19 in the acute phase of the Italian outbreak

To assess the contribution of caregiver and child depressive and anxiety symptoms severity to child asthma-related quality of life (QoL), apart from explanation by demographics and asthma control to QoL.The study population consisted of 205 caregiver-child pairs from Dallas, Texas, and Buffalo, New York, from June 2016 to December 2020. The study included children aged 7 to 17 years with a diagnosis of persistent asthma (classified by either of the following criteria: [1] requirement for treatment with daily controller medication or [2] symptoms of persistent asthma in children not on a daily controller medication with any of the following: [1] daytime symptoms 2 or more days per week; [2] rescue bronchodilator use 2 or more times per week; [3] nocturnal symptoms 2 or more nights per month; or [4] 2 or more oral steroid bursts in the past year). The study also included primary caregivers of the children under study. All caregivers met the criteria for major depressive disorder (MDD) based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria and diagnosed using a structured clinical interview.Participants of the study were observed every 4 weeks for a year. Child asthma-related quality of life was assessed with Pediatric Asthma Quality of Life Questionnaire (PAQLQ) total scores. Asthma control was measured with Asthma Control Test (ACT) or Childhood ACT (cACT). Caregiver depressive symptoms were measured by Hamilton Rating Scale for Depression (HRSD); caregiver anxiety symptoms were measured by State-Trait Anxiety Inventory (STAI). Child depressive symptoms were measured with Children’s Depression Inventory (CDI); child anxiety symptoms were measured with Screen for Child Anxiety Related Emotional Disorders Inventory (SCARED). A 3-stage hierarchical linear regression analysis was performed with PAQLQ total scores as the outcome of child asthma-related QoL. The following predictors were included for the 3 stages of linear regression: demographic characteristics for stage 1; asthma control (ACT, cACT) for stage 2; and caregiver depression (HRSD), caregiver anxiety (STAI), child depression (CDI), child anxiety (SCARED) for stage 3.The study analyzed data from a total of 205 child-caregiver pairs. The average age for children was 11 (±3) years, and 38 (±8) years for caregivers. Most participants were female (caregiver 98%, child 54.1%) and of Black race (caregiver 52.2%, child 56.6%). For the first stage of the hierarchical linear regression, demographic variables (child sex, age, caregiver educational level, caregiver race, caregiver ethnicity) contributed to 5.5% of variance in QoL. It was found that only child sex had a significant association with QoL, where males reported a higher QoL. For the second stage, asthma control (ACT/cACT) was included in the regression, which significantly increased explained variance to 32.6%. Asthma control was thus found to be a strong predictor of QoL, with better asthma control indicating a better QoL. For the third stage, the inclusion of child and caregiver anxiety and depression scores significantly increased explained variance to 42.6%. Child anxiety (SCARED scores) was found to be the only statistically significant mood-related predictor (P < .001, β = −0.332). This finding indicated that higher child anxiety scores were associated with lower asthma-related QoL. Asthma control had the most significant contribution to QoL variance as it was seen by a squared structure coefficients (rs2) score of 0.702, then child anxiety (rs2 score = 0.584), and lastly child depression (rs2 score = 0.343).Child and caregiver depression and anxiety have a pertinent influence on child asthma-related QoL after adjusting for demographic characteristics and asthma control. Specifically, child anxiety scores were found to be statistically significant predictors of diminished QoL.The study addresses the contribution of caregiver and child mood symptoms, specifically depression and anxiety, to pediatric asthma-related QoL. The finding of a significant and unique contribution of child anxiety to asthma-related quality of life adds to the necessity of addressing mental well-being in addition to physical health in pediatric asthma management. This study adds to the literature supporting the need for integrated medical and behavioral models of asthma management to improve asthma-related QoL in the pediatric population with asthma. This can include the addition of routine screening and treatment of anxiety and depression in both children with asthma and their primary caregivers into asthma management guidance. Further study should also focus on the implementation of integrated medical-psychological models for pediatric asthma management and explore barriers to application, access, and quality of model implementation, especially in high-risk, underserved, and underresourced populations.

Mental health in secondary school-aged children with epilepsy and their primary caregivers: A case control study

To provide a review of the literature comparing anxious and depressive symptoms in caregivers of children with asthma with caregivers of healthy children. A systematic search identified 25 studies from 17 articles, reporting outcomes on 4,300 caregivers of children with asthma and 25,064 caregivers of healthy children. Overall, anxious (d = 0.50) and depressive symptoms (d = 0.44) were higher in caregivers of children with asthma compared with caregivers of healthy children. Age, site of recruitment, and whether the asthma diagnosis was medically confirmed were included as potential moderators. The relationship between parental psychopathology and asthma was stronger in those with medically confirmed asthma and participants recruited from clinical settings. Other moderators were not significant. Caregivers of children with asthma appear to have greater anxious and depressive symptoms than caregivers of healthy children, but the reasons are unclear. More research that investigates modifiable factors that may moderate this association is urgently needed.

Mental health and parenting characteristics of caregivers of children with spina bifida

Trauma from witnessing events such as bombings and killings as well as direct victimization or participation in violence has been associated with psychosocial distress and poor mental health among war-exposed children and adolescents. This study examines the relationship between caregiver mental health and child internalizing (anxiety and depression) symptoms over a 4-year period in postconflict Sierra Leone. The sample included 118 adolescent Sierra Leonean youth (73% male; mean age = 16.5 years at Time 1) and their caregivers (40% male; mean age = 39.0 at Time 1). To measure depression and anxiety symptoms, the Hopkins Symptom Checklist-25 was used with adults and the Oxford Measure of Psychosocial Adjustment - previously validated for use with children and adolescents in the region - was used to assess youth. A multivariate hierarchical linear model (HLM) for studying change within dyads was implemented to study covariation in internalizing symptoms among caregivers and youth over time; these models also included covariates at the individual, family and community levels. The relationship of caregiver mental health to child's internalizing was tested in a latent variable extension of the HLM. The latent variable extension estimated that a one standard deviation (SD) change in caregiver anxiety/depression was associated with a .43 SD change in youth internalizing (p < .01) over the 4-year period. Family acceptance was negatively related to youth internalizing (p < .001), while community stigma was positively associated (p < .001). The findings highlight an important interplay between caregiver and child mental health within the postconflict setting and the need for psychosocial interventions to extend beyond the individual to account for family dynamics.

Evidence from predominately non-Hispanic White populations indicates that emergency room (ER) admissions and hospitalizations by older adults with and without dementia are associated with caregiver stress and depressive symptoms. These results may not generalize to Hispanic populations because of cultural differences in caregiving roles, responsibilities, and perspectives about care burden. Investigate the association between ER admissions and hospitalizations by Mexican American older adults with and without dementia and symptoms of depression and stress among family caregivers. Data came from the 2010/11 wave of the Hispanic Established Populations for the Epidemiologic Study of the Elderly and Medicare claims files. The final sample included 326 older adults and their caregivers. Negative binomial regression was used to model the association between hospitalizations and ER admissions by older adults in the previous two years and caregivers' depressive symptoms and stress in 2010/11. The number of older adult ER admissions and hospitalizations was not associated with caregiver depressive symptoms. Two or more ER admissions (incident rate ratio [IRR] = 1.26, 95% CI = 1.05-1.51) and two or more hospitalizations (IRR = 1.32, 95% CI = 1.07-1.61) were associated with significantly higher caregiver stress. Additionally, ER admissions and hospitalizations for a circulatory disease or injury and poisoning were associated with significantly higher caregiver stress. These associations were not modified by the care recipient's dementia status. Hospitalizations and ER admissions by older Mexican Americans were associated with greater caregiver stress but not depressive symptoms. These associations were similar for caregivers to older adults with and without dementia.

Family take the role of caregivers and provide the mentally ill member with help, care and support. Caregivers are at the high risk to anxiety and depression. The main objective of the research was to assess anxiety and depressive status among caregivers of mentally ill patients attending Mental Hospital, Lalitpur, Nepal. A cross sectional study based on clinical setting was conducted among 184 caregivers of mentally ill patients attending outpatient department of Mental Hospital, Lagankhel, Lalitpur, Nepal. Purposive sampling technique was used for the study. Pre-tested semi-structured questionnaire and validated Nepali translated version of hospital anxiety and depression scale was used to assess anxiety and depressive status among caregivers. The collected data was entered in Microsoft Excel 2013 and data analysis was done in Statistical Package for Social Sciences (SPSS) international business machine version 25. Ethical consideration was maintained during the study. Anxiety and depressive symptoms among caregivers of mentally ill patients was 24.5% and 19.6% respectively. Risk factors significantly associated with anxiety and depressive symptoms in caregivers were sex of caregiver, socio-economic status and sex of patient. Types of mental illness of patient was also significantly associated with anxiety while educational status was significantly associated with depressive symptoms in caregivers. Anxiety and depressive symptoms were found among caregivers of mentally ill patients. It is high time to consider mental health of caregiver and mental health promotion programs and policies for caregivers should be implemented.